Health and Welfare
As indicated by their long life expectancy and low death rates, Singaporeans generally enjoyed good health. Standards of nutrition and environmental sanitation were high. The Ministry of the Environment's Vector Control and Research Department was responsible for controlling mosquitoes, flies, rats, and other disease-bearing animals; the Food Control Department and the Hawkers Department inspected food producers and outlets for cleanliness and sanitation. The Ministry of the Environment's Public Affairs Department conducted educational campaigns on such topics as environmental sanitation, control of mosquito-breeding sites, proper disposal of refuse, and food handling. Educational efforts were backed up by sanctions, which included fines of up to S$500 for spitting or failing to flush public toilets.
The population was served by nine government hospitals with 7,717 beds and by twelve private hospitals with 2,076 beds. In 1987 the Ministry of Health certified 2,941 physicians, 9,129 nurses, 653 dentists, and 487 pharmacists. Five of the nine government hospitals were general hospitals, providing a complete range of medical services and twenty-four hour emergency rooms, and the other four each had a specialty: obstetrics and gynecology, dermatology and venereology, psychiatry, or infectious diseases. In 1987 the Ministry of Health's Community Health Service operated twenty-four clinics in major housing complexes, offering primary medical treatment for injuries and common diseases. The Maternal and Child Health Service provided preventive health care for mothers and preschool children at twenty-three clinics, while school children were served by the School Health Service.
Government hospitals and clinics charged fees for their services, although the fees were generally low and the medical services were heavily subsidized. The fees were intended to discourage frivolous use of the medical system and to demonstrate that residents were responsible for their own health costs, as Singapore was not a welfare state. After 1984 Singaporeans could pay for their medical expenses through the Medisave Scheme, under which 6 percent of the monthly income of every contributor to the Central Provident Fund could be set aside for the medical expenses of the contributor and the contributor's spouse, parents, grandparents, and children in all government or private hospitals.
Mortality and Morbidity
The major causes of death in 1986 were heart disease, accounting for 24 percent of all deaths; cancer, 23 percent; cerebrovascular disease, (stroke) 11 percent; and pneumonia, 8 percent. In 1988 two minor outbreaks of dengue fever took place but were halted through prompt control of arthropod-borne microorganisms, and a minor cholera epidemic broke out among the inmates of a mental institution. In 1982 the World Health Organization (WHO) declared Singapore malaria-free, and 161 of the 165 cases of malaria reported in 1987 were determined to be imported. In 1987 the most serious epidemic disease was hepatitis; 752 cases of acute viral hepatitis and 11 deaths were reported. Noise-induced deafness and industrial-related skin disease the major occupational diseases; there was also some concern over exposure of workers to toxic and carcinogenic substances and to asbestos. The health authorities paid special attention to patients with kidney failure, a condition that which killed some 200 people a year. The number of deaths reflected inadequate dialysis facilities and a shortage of organ donors. The 1987 Human Organ Transplant Law gave doctors the right to remove the kidneys of those killed in accidents unless the victim had objected in writing or was a Muslim.
At the end of 1988, the Ministry of Health reported thirty-four cases of acquired immune deficiency syndrome (AIDS) among Singaporeans; four of these cases resulted in death. The first two cases were identified in 1985. Thereafter the incidence increased; five new cases were reported in December 1988 alone. In 1987 the Ministry of Health established an AIDS Task Force to inform health professionals of research on and treatment programs for the disease. A National Advisory Committee, also formed in 1987, with representatives from the Ministry of Health, other ministries, the public media, hotels, and travel agencies concentrated on educating the public about the disease. The Ministry of Health worked with WHO, adapting its information and strategies to local circumstances. All blood donors were routinely screened for AIDS, and blood screening could be done at designated government clinics. In 1989 the Ministry of Health was sponsoring education programs on AIDS and offering confidential counseling to people worried that they might be infected. The ministry was trying to reach members of high-risk groups, but many of them refused counseling from fear of being identified and stigmatized.
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